Provider Demographics
NPI:1336458603
Name:MAHANCRESCIMANNO, PATRICIA MARIEEILEEN (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIEEILEEN
Last Name:MAHANCRESCIMANNO
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KRISTEN LEAH LN
Mailing Address - Street 2:
Mailing Address - City:SALISBURY MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12577-5324
Mailing Address - Country:US
Mailing Address - Phone:845-215-6019
Mailing Address - Fax:
Practice Address - Street 1:50 MONTEBELLO RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-3824
Practice Address - Country:US
Practice Address - Phone:845-357-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012672225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics